Provider Demographics
NPI:1184854630
Name:EVENTUS MAINE LLC
Entity Type:Organization
Organization Name:EVENTUS MAINE LLC
Other - Org Name:WESTBROOK PSYCHOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-782-7720
Mailing Address - Street 1:68 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2203
Mailing Address - Country:US
Mailing Address - Phone:207-782-7720
Mailing Address - Fax:207-333-3232
Practice Address - Street 1:1180 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5059
Practice Address - Country:US
Practice Address - Phone:207-782-7720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-18
Last Update Date:2009-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty